| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
48,904 |
48,672 |
$2.72M |
| D1120 |
Prophylaxis - child |
63,536 |
63,148 |
$2.48M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25,002 |
12,457 |
$1.63M |
| D1351 |
Sealant - per tooth |
37,892 |
11,754 |
$987K |
| D1310 |
|
20,677 |
20,594 |
$934K |
| D1208 |
Topical application of fluoride, excluding varnish |
59,372 |
59,022 |
$873K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,488 |
4,612 |
$866K |
| D0230 |
Intraoral - periapical each additional radiographic image |
203,151 |
52,285 |
$841K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
20,064 |
19,374 |
$788K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14,163 |
7,621 |
$742K |
| D9993 |
|
9,303 |
9,295 |
$599K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,861 |
7,840 |
$503K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,348 |
4,894 |
$468K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,460 |
5,437 |
$340K |
| D0274 |
Bitewings - four radiographic images |
16,059 |
15,973 |
$322K |
| D0272 |
Bitewings - two radiographic images |
25,691 |
25,535 |
$282K |
| D3240 |
|
2,546 |
1,770 |
$249K |
| D0350 |
|
22,565 |
12,684 |
$245K |
| D0603 |
|
14,328 |
14,259 |
$211K |
| D0220 |
Intraoral - periapical first radiographic image |
13,579 |
13,369 |
$156K |
| D0210 |
Intraoral - complete series of radiographic images |
2,537 |
2,504 |
$98K |
| D2330 |
|
1,179 |
718 |
$90K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,141 |
886 |
$88K |
| D9430 |
|
2,603 |
2,560 |
$81K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
604 |
378 |
$60K |
| D0602 |
|
2,793 |
2,785 |
$42K |
| D0330 |
Panoramic radiographic image |
1,298 |
1,297 |
$37K |
| D0601 |
|
1,395 |
1,394 |
$20K |
| D1510 |
|
51 |
50 |
$10K |
| D2932 |
|
86 |
40 |
$9K |
| D9221 |
|
17 |
12 |
$6K |
| D9220 |
|
12 |
12 |
$3K |
| D1206 |
Topical application of fluoride varnish |
505 |
501 |
$3K |
| D0270 |
|
414 |
411 |
$2K |
| D1354 |
|
67 |
65 |
$2K |
| D9610 |
|
12 |
12 |
$987.00 |
| D1999 |
|
37 |
37 |
$276.00 |
| D1330 |
|
193 |
187 |
$0.00 |